| NPI | 1417918442 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KS 74729) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 13-40012-022) |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2024-04-03 |